Cancer Centers in the News

The following links highlight some of the most up-to-date news from the 27 NCCN Member Institutions. The media coverage below includes major national news outlets, industry magazines, medical journals, and press releases.

The news is listed in reverse chronological order for ease of use.

11/30/2016Improving the Utility of Value Tools in Cancer Care for Patients

NCCN will host its annual patient advocacy summit on December 9 in Washington, DC to explore gaps in current value tools, as well as patient definitions of value.

(FORT WASHINGTON, PA, November 30, 2016) — Across the oncology field, there is a mounting pressure to improve quality and define value of cancer care from a patient perspective. This need to define value is recognized by key stakeholders in oncology, a variety of whom have begun to develop value tools and calculators to determine the most valuable treatment options. Intended for use in the shared decision-making process, these tools must reflect the most accurate and timely treatment options and evaluate value based on individual patients’ needs and preferences. Therefore, it is imperative that these tools not only provide information to help patients make decisions regarding their cancer care, but that they do so in a way that is easily attainable and understandable for patients. Despite current innovative tools and initiatives around value, there still exists a significant need for additional patient-centered value tools.

On Friday, December 9, 2016, the National Comprehensive Cancer Network® (NCCN®), as part of its Oncology Policy Program, will convene its annual Patient Advocacy Summit at the National Press Club in Washington, DC. This year’s summit, Value Tools for Patients in Cancer Care, will highlight the findings and recommendations of NCCN’s multi-stakeholder Value Tools for Patients in Cancer Care Working Group, which included patients, patient advocates, clinicians, social workers, and financial planners. The summit will bring together these stakeholder groups, as well as payers, industry, and government representatives, to explore how patients define value in cancer care; and discuss the gaps, needs, and utility of value tools for patients.

Moderated by Clifford Goodman, PhD, The Lewin Group, the summit will commence with a Working Group report delivered by Alan Balch, PhD, Patient Advocate Foundation, and Lisa Lentz, MPH, NCCN, followed by a panel discussion of the gaps in current tools and how to address these gaps in decision-making preparedness. The first panel discussion, Gaps of Value Tools for Patients in Cancer Care, features the following experts:

The second half of the summit will focus on the utility of value tools for patients, beginning with a demonstration of a Breast Cancer Surgical Decision Support iPad Tool by Sandhya Pruthi, MD, of Mayo Clinic Cancer Center, followed by an expert panel discussion titled, Understanding Principles and Parameters of Value Tools for Patients in Oncology. The second roundtable will cover the challenges to and feasibility of widespread adoption of value tools, as well as how to adopt standard processes with individual needs of the patient. The following experts will participate in the panel:

(FORT WASHINGTON, PA, November 10, 2016) As part of its mission to improve the quality, effectiveness, and efficiency of cancer care so that patients can live better lives, the National Comprehensive Cancer Network® (NCCN®) today announced the launch of Just Bag It: The NCCN Campaign for Safe Vincristine Handling. This campaign encourages health care providers to adopt a policy to always dilute and administer vincristine in a mini IV-drip bag to prevent a deadly medical error.

Vincristine is a chemotherapy agent, widely used in patients with Leukemia or Lymphoma, which should be administered intravenously, or directly into the patient’s vein. When it enters the blood, it is highly effective at blocking the growth of cancer by preventing cells from separating. However, vincristine is a neurotoxin that causes peripheral neuropathy when given intravenously and profound neurotoxicity if given into the spinal fluid, which flows around the spinal cord and brain.

Many patients who receive vincristine have a treatment regimen that includes other chemotherapy drugs that are administered intrathecally, or injected into the spinal fluid with a syringe. If vincristine is mistakenly administered into the spinal fluid, it is uniformly fatal, causing ascending paralysis, neurological defects, and eventually death.

In 2005, NCCN Chief Executive Officer Robert W. Carlson, MD, a medical oncologist, witnessed such a tragedy with a 21 year-old patient with Non-Hodgkin’s Lymphoma named Christopher Wibeto. Wibeto was transferred to Carlson’s care after receiving incorrectly administered vincristine at another hospital. Carlson watched the young man go from having a likely curable condition to deteriorating and dying within four days. Motivated by this tragic experience, Carlson spearheaded a national effort to address this deadly error when he arrived at NCCN, enlisting the help of its Best Practices Committee, which is dedicated to improving cancer treatment protocols.

To ensure that vincristine is always administered properly, NCCN has issued guidelines advising health care providers to always dilute and administer vincristine in a mini IV-drip bag and never use a syringe to administer the medication. This precaution renders it impossible to accidentally administer the medication into the spinal fluid and greatly decreases the chances of improper dosage.

“We are proud of this achievement and grateful for the support and participation of our Member Institutions in reaching this goal,” Carlson said. “Our efforts will not stop here. We challenge all medical centers, hospitals, and oncology practices around the nation and the world to implement this medication safety policy so this error never occurs again.”

Surveys issued by the Institute for Safe Medication Practices (ISMP) show that over time, more hospitals have adopted a policy to always bag vincristine. According to ISMP data, the number of hospitals that have fully implemented the policy across their practice nearly doubled between February 2014 and February 2016. Earlier surveys indicated a similar increase between 2005 and 2012. Still, only about half of all respondents indicated that they have implemented the policy in all treatment settings, indicating that there is a long way to go.

With 125 known cases of accidental death in the U.S. and abroad since the inception of vincristine use in the 1960s, this error is relatively rare. Still, it is unique in its level of mortality. Improvements in practice over the years, including manufacturer- and pharmacist-issued warning labels, have reduced the number of deaths, but the error continues to occur.

Diluting vincristine into a mini IV-drip bag may entail a change in practice for some providers, but it is well worth the outcome of avoiding preventable deaths, according to Michael Cohen, RPh, MS, FASHP, President of ISMP.

“One more life taken is one too many,” Cohen said. “We are glad an organization of NCCN’s influence has stepped up to bring this issue to national attention. Ending this devastating error should be a priority for all of us who care for and advocate on behalf of patients and their families.”

Some health care providers may associate the use of an IV bag with a heightened risk of extravasation, or the leaking of a chemotherapy drug into the tissue surrounding the intravenous administration site. But research shows that the risk of extravasation is extremely low (<.05%) regardless of how vincristine is administered.1

“The Just Bag It campaign is the latest of NCCN’s long-standing efforts to improve the safe use of drugs in cancer care,” said F. Marc Stewart, MD, Medical Director of the Seattle Cancer Care Alliance, Member of the Fred Hutchinson Cancer Research Center, Professor of Medicine at University of Washington, and Co-Chair of the NCCN Best Practices Committee. “For more than 15 years, the Best Practices Committee has worked to ensure the highest standards of safety for patients.”

In 2008, the Best Practices Committee led the charge for NCCN to begin publishing Chemotherapy Order Templates (NCCN Templates®), which detail the most common regimens for many cancers and highlight safety parameters. These resources enable practitioners to standardize patient care, reduce medication errors, and anticipate and manage adverse events. There are more than 1,500 NCCN Templates® for 86 cancer types, and they are used by more than 10,000 subscribers.

For more information about Just Bag It: The NCCN Campaign for Safe Vincristine Handling, or to report that a medical facility has adopted a vincristine policy, visit www.NCCN.org/JustBagIt.

As published in JNCCN, a recent project out of Canada shows that programs identifying stress and distress in patients with cancer increase health care professionals’ confidence and awareness of patient-centeredness; outcomes are influenced by site-based navigators and practice size.

FORT WASHINGTON, PA — As many as 60 percent of patients with cancer report distress following a cancer diagnosis, and this stress can have significant impacts on patients’ well-being, resulting in psychosocial problems, physical side effects, and dissatisfaction with their health care.

To examine the impact of distress on patients and health care professionals (HCPs), Linda Watson, PhD, RN, CancerControl Alberta, Alberta Health Services, led the implementation of screening for distress (SFD) as a new standard of care across 17 provincial cancer care sites. More than 250 HCPs across cancer care facilities in Alberta, Canada, participated in educational sessions and adopted this standard of practice. Dr. Watson and Dr. Rie Tamagawa, a senior researcher in provincial practices, found that HCPs who participated in this educational program and utilized SFD routinely reported improved confidence in detecting patient distress and increased awareness of the importance of a patient-centered approach to care.

“Distress can be caused by a variety of issues, concerns, or symptoms, but how distress is experienced and what underlies a person’s distress is unique to each person and changes over time. The SFD helps clinicians identify distressed patients and their issues, concerns, or symptoms driving their distress. This project has demonstrated that through clinical review and targeted response to the patient priority issue, improved clinical outcomes and patient experiences can be achieved,” said Dr. Watson.

For Dr. Watson’s quality improvement project, the SFD intervention was implemented as a standard of care at all cancer care facilities in Alberta over a 10-month period. HCPs at all sites completed educational sessions prior to implementation of this new practice. HCPs also completed surveys before and after implementation. Results of the project illustrated a significant increase in participants’ confidence in identifying, assessing, and managing distress, as well as their awareness of person-centered care principles following the implementation. HCPs at smaller community cancer centers reported greater person-centered awareness as compared to HCPs at larger tertiary sites throughout the study. HCPs at those smaller sites identified more benefits from the SFD intervention relative to HCPs at the larger sites.

This variance, Dr. Tamagawa reports, is likely because smaller, more remote cancer centers have patient navigation as part of their model of care and physicians are treating multiple tumor types. These are likely to contribute to personable patient-provider relationships. The benefits of the SFD was more salient for HCPs taking care of multiple tumor types, suggesting that such intervention is well adopted by physicians who practice as generalist model of care. On the other hand, physicians from larger centers tend to be single-tumor specialists at hospitals that do not employ patient navigation programs—these participants reported lower awareness in person-centeredness in general, and the SFD intervention potentially posed an additional workload. Prior to adequate SFD training and with less time for patient relationship-building, physicians often lack confidence in their ability to identify and treat patient distress in a timely manner. The study highlighted that SFD intervention can help build this confidence and awareness of person-centered care delivery regardless of the types of care facilities.

In Alberta, Dr. Watson shared, “We have found that utilizing a SFD tool that spans the physical, emotional, social, spiritual, practical, and informational domains has been helpful as it reflects the whole patient experience. It has been our experience that using a tool that helps the patient to specify their particular area of concern facilitates meaningful interventions.”

“Patient distress has received little attention from clinicians, but can have a large impact on patient quality of life. As such, screening for distress will become increasingly important in clinical practices, so information on its implementation is useful for practitioners,” said Jimmie C. Holland, MD, Wayne R. Chapman Chair in Psychiatric Oncology, Memorial Sloan Kettering Cancer Center, and Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Distress Management.

Complimentary access to the article is available until December 15, 2016 at JNCCN.org.

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About JNCCN – Journal of the National Comprehensive Cancer Network
More than 24,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

New NCCN Guidelines for Myeloproliferative Neoplasms focus on the treatment of Myelofibrosis, a rare bone marrow cancer; the new recommendations are the most comprehensive treatment guidance available to U.S. clinicians today.

FORT WASHINGTON, PA — Myeloproliferative Neoplasms (MPN) are a group of blood cancers characterized by significant symptoms and a high risk of transformation into acute leukemia. These cancers—Myelofibrosis, Essential Thrombocythemia (ET), and Polycythemia vera (PV)—affect approximately 13,000, 134,000, and 148,000 patients in the United States, respectively.1

To provide clinicians with the most up-to-date and comprehensive treatment recommendations, the National Comprehensive Cancer Network® (NCCN®) today published the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for MPN to specifically outline diagnosis, treatment, and supportive care strategies for Myelofibrosis. Myelofibrosis is a type of MPN that is the result—in most cases—of one of three genetic mutations within the JAK2 signaling pathway. Comprehensive recommendations for the management of ET and PV will be included in the subsequent versions of the NCCN Guidelines® for MPN.

NCCN Guidelines document evidence-based consensus-driven management to ensure that all patients receive preventive, diagnostic, treatment, and supportive care services that are most likely to lead to optimal outcomes.

Ruben A. Mesa, MD

“The management of MPNs has been variable in the past and largely driven by review articles and individual opinions. The NCCN Guidelines Panel for MPN hopes these inaugural Guidelines will help leverage the evidence base in MPN care for clear, well-informed, treatment guidelines to hopefully improve quality of care and provide better outcomes for patients with MPN,” said Ruben A. Mesa, MD, FACP, Mayo Clinic Cancer Center, Chair of the NCCN Guidelines Panel for MPN.

Dr. Mesa will present the new NCCN Guidelines in an educational setting during the NCCN 11th Annual Congress: Hematologic Malignancies™ on Friday, September 30, in a session titled, “Myeloprofilerative Neoplasms and Myelofibrosis: Evolving Management.” To register, visit NCCN.org/HEM.

With the publication of the NCCN Guidelines for MPN, the library of NCCN Guidelines now includes 63 clinical guidelines detailing sequential management decisions and interventions that currently apply to 97 percent of cancers affecting people in the United States, as well as cancer prevention, detection and risk reduction, and age-related recommendations.

Available free-of-charge to registered users of NCCN.org and through the Virtual Library of NCCN Guidelines Mobile Apps, NCCN Guidelines help oncologists make the major clinical decisions encountered in managing their patients by providing ready access to synthesized information. The NCCN Guidelines provide recommendations for appropriate care for most, but not all patients; however, all individual patient circumstances must be considered when applying these recommendations.